PCOS or polycystic ovary syndrome is a hormonal disorder common among women of reproductive age and its prevalence ranges between 9.13% to 36% in India and it’s increasing yearly. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.
Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin.
PCOS hair loss occurs due to an increase in the male hormone (known as androgen) in the body. These excess androgens trigger hair thinning on the scalp. However, there is not complete baldness as seen in men.
The major hormones that play a vital role are testosterone and androstenedione. Other androgens include dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S).
These are commonly called male hormones and naturally produced within the ovaries, the adrenal glands, and the fat cells of a women’s body.
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These play a key role in puberty by stimulating pubic and underarm hair growth. They control the degree and frequency of blood loss during menstruation and they become converted into oestrogen.
Androgen levels in women are much lower than in men so when the ovaries turn into cysts and then produce too much of these, they can block the hair follicles thus causing what is called androgenic alopecia or AGA.
The affected hair becomes thinner in diameter, shorter in length, and lighter in colour until it is finally not produced at all. This is also referred to as female-pattern hair loss or FPHL. Hair thinning and loss starts at the parting on the crown of your head and then gradually spreads so that it involves most of the top of the head so that the scalp shows through – especially indirect light. Eventually, this hair loss can become severe, leading to near-baldness, especially as women pass through menopause.
The main culprit here is DHT which binds to the receptors in the scalp follicles and shrinks those follicles making it impossible for healthy hair to survive. This is exacerbated by the fact that lack of ovulation has caused a lack of progesterone which would normally bind to those same receptors preventing hair loss from happening in the first place.
Here’s how you can stop hair fall associated with PCOS
1. Oral contraceptives (OCP) in combination with spironolactone
2. Diane-35 (containing cyproterone acetate and Ethinyl estradiol)
3. OCP in combination with a 5-alpha reductase inhibitor
4. OCP with flutamide
5. Multiple drug therapy
Although the above medical treatments are effective in controlling the androgenic alopecia, they are not frequently used or recommended by the FDA for use in women with alopecia, nor in hirsutism.
It requires careful self-evaluation and both hair specialists and endocrinologists need to follow-up with the patients to control both hormones and hair loss.
Recent studies and research advances showed new formulations that will benefit the woman with alopecia and reduce the emotional impact.
PCOS can affect both your physical and mental health—especially when it causes visible symptoms like hair loss.
Hair loss due to PCOS lasts as long as androgens block your hair follicles, and DHT binds your hair follicle receptors. The treatment takes a few weeks to clear the excess androgens and DHT, and increase oestrogen and progesterone levels and this must be regulated until we control the hormones we can’t control hair loss.
We cannot control excess hair loss with herbal treatments and essential oils and other home remedies because here the problem lies in hormones and this can be only regulated by consulting your endocrinologist and hair specialist.